Q: What could be the treatment of heparin induced hyperkalemia secondary to aldosterone suppression?
The mechanism of heparin induced hypoaldosterone inhibition is thought to be suppression of aldosterone synthesis through a reduction in the number and affinity of angiotensin II receptors in the adrenal zona glomerulosa. This process dampens the stimulation by the renin–angiotensin system of retention of sodium and excretion of potassium. The maximum antagonism of aldosterone effects by heparin occurs after 4–6 days of therapy and may occur at any dosage.
Hypoaldosterone state induced by heparin is antagonized by fludrocortisone. Short-term use of fludrocortisone is a good option in hyperkalemic patients until the need for heparin therapy elapses.
Sherman DS, Kass CL, Fish DN. Fludrocortisone for the treatment of heparin-induced hyperkalemia. Ann Pharmacother. 2000;34(5):606–610